This article has been updated with comments from Opternative and the Virginia House of Delegates.

In stark contrast to the law that past last year in South Carolina, the state of Virginia has proactively passed a pro-telemedicine bill that protects the rights of optometrists and ophthalmologists to see patients and issue prescriptions via telemedicine.

The law, signed late last month, states that “for the purpose of a provider prescribing spectacles, eyeglasses, lenses, or contact lenses to a patient, a provider shall establish a bona fide provider-patient relationship by an examination (i) in person, (ii) through face-to-face interactive, two-way, real-time communication, or (iii) store-and-forward technologies.”

“Today, the Commonwealth struck a good balance,” Virginia State Delegate Peter Farrell, one of the sponsors of the legislation, said in a statement last month. “We have signaled to entrepreneurs that their ideas and innovations are welcome in our state. As we empower doctors to utilize these new telemedicine options that will increase access to healthcare and lower costs, we have also made sure that the health and safety of our residents comes first.”

The law was the result of lobbying by telemedicine eye care companies, who have undertaken lobbying in response to local optometry and ophalmology industry groups seeking legislation to oppose them. The most prominent example of this so far is in South Carolina, where Chicago-based Opternative is currently suing the state over a law forbidding online or app-based eye exams. Opternative considers the law anti-competitive and in violation of South Carolina’s constitution. The American Optometric Association, which lobbied for the legislation and opposes the suit, holds that technology like Opternative’s endangers patients.

Opternative was one part of a group of ocular telemedicine companies that worked for the legislation, which also included 1800Contacts and Simple Contacts, an NYC-based startup that raised $2 million in November. It was Simple Contacts that original made MobiHealthNews aware of the bill, but Opternative told MobiHealthNews in an email that not all parties contributed equally to that effort and that “Simple Contacts never showed up for the committee hearings or spent one day on the ground lobbying in Virginia”. Correction: A previous version of this story said EyeNetra was involved in lobbying for this bill. That was in error.

In a Medium post, Simple Contacts founder and CEO Joel Wishkovsky said that Virginia passed the law after being approached by industry groups about passing an anti-telemedicine law, but after meeting with telemedicine groups, ended up doing just the opposite.

“The Virginia State Legislature, when approached to pass a law that would ban our technology, decided to take a closer look,” he wrote. “They spoke to dozens of medical experts and determined that what Simple Contacts and many other telemedicine platforms do is not only safe, but is good for their constituents. Last week, they passed HB 1497, a law that explicitly recognizes the potential of ocular telemedicine and sets common sense guidelines on its use to ensure only high quality care is delivered.”

The law does provide a list of conditions in-person or remote eye doctors must meet. They must obtain an updated medical history, conform to the standard of care, and be licensed in Virginia, among other requirements. The law also says the prescription cannot be “determined solely by use of an online questionnaire”.

While the Virginia law was something of a happy accident, Wishkovsky is hopeful that other states will follow Virginia’s lead to protect telemedicine from the get-go.

“Virginia is the first state to pass these protections, and will serve as a blueprint for others that want to encourage telemedicine to flourish,” he wrote. “As product builders, we didn’t anticipate that helping patients would be controversial, but it is clear that some industry players are interested in preserving the old way at any cost. Unfortunately the patients are the ones who bear that cost. So we have no choice — we’ll be there, across the country, engaging with legislators, regulators and groups that want to advance healthcare to protect patient’s interests and fulfill our mission of making healthcare simpler and more convenient.”

The promise of telemedicine is ‘care anywhere’, but what happens when ‘anywhere’ is an area with little to no connectivity or reception? Lexington, Massachussets-based SwyMed is looking to tackle that conundrum with its DOT Telemedicine Backpack, unveiled today in advance of the HIMSS Annual Conference in Orlando next month.

The lightweight backpack contains four high-gain antennae, two modems, a rugged tablet, a fifteen-hour battery, and various tools like stethoscopes and ultrasounds. The idea is for paramedics and home healthcare workers to increase the amount of care they can provide via telemedicine, diminishing the need for expensive emergency department visits.

“At the end of the day, the first responders, there’s only so many things you can train them on or that they should have to be responsible for. If they have to be an IT technician as well as a healthcare technician, you’ve vastly increased their workload,” Jeffrey Urdan, chief operating officer of SwyMed, told MobiHealthNews. “What do you today? You dial on the radio, call on the phone, you describe what you see, the doctor kind of makes the best guess at what you’re describing and it’s just a longer, more complicated interaction. With this technology, you walk into the house with a backpack, you fire up a video conference, and the doctor can interact with the patient directly. The doctor is in the kit.”

The backpack can potentially be used for a lot of use cases, not just for first responders but also for making preventative visits to people with known chronic conditions who might have a hard time getting to the hospital, or for nursing homes that want to cut down on unnecessary hospital visits.

“We’re actually working with Texas Tech on a program right now, and they’ve got these enormous travel distances,” Urdan said. “The current standard of care is to go to the closest hospital, stabilize a patient, [and] a lot of time that means they drive a long way, they get to the hospital, and then they get transferred to the University Medical Center and that’s another hour. The idea is to be able to do that triage in the field. So you send the patient where they need to go, once. For that kind of thing it’s a pretty cool application.”

In rural areas, Urdan added, the cost savings are pretty apparent. “If you save one helicopter flight, you’ve just paid for the whole system,” he said.

Evie Jennes, chief commercial officer at SwyMed, says that the final product of the backpack is the culmination of several different streams of R&D for SwyMed.

“I think you have to have all the pieces of the puzzle,” she said. “And it took us some time to put them all together. Our software is key, because the software needs to work very well on low bandwidth. … The second thing is the hardware configuration. That took months and months. And the third piece – and a very important piece – is the relationship we have with Verizon. We’re part of their priority program. When you combine those three things together, you can deliver the DOT Telemedicine backpack that we released today.”

Legislators have resubmitted a bill that would remove rural limits and expand Medicare coverage of telestroke services nationwide. Proponents say the bill could save the lives of millions of stroke victims.

February 17, 2017 – Congress is set to revisit a bill that would expand Medicare reimbursement nationwide for telestroke services.

The Furthering Access to Stroke Telemedicine (FAST) Act, originally introduced in 2015, would alter the Social Security Act to allow Medicare coverage of telestroke services no matter where the patient is located. Current legislation allows those services only in certain rural areas.

U.S. Reps. Morgan Griffith (R-Va.) and Joyce Beatty (D-Ohio), who co-sponsored the original legislation, made the announcement this week that they have reintroduced the bill, with the support of the American Heart Association and American Academy of Neurology.

Both said they want to apply telemedicine technology that has proven its value in combatting the nation’s fifth leading cause of death.

“The FAST Act, as the name implies, will help more stroke victims gain faster access to high-quality care through remote evaluation and treatment – commonly called telestroke,” Beatty said in a press release. “As a stroke survivor and co-chair of the Congressional Heart and Stroke Coalition, I know firsthand how minutes can literally mean the difference between life and death. That is why I proudly join Congressman Griffith in reintroducing the FAST Act to ensure telestroke is readily available to more people.”

“This critical bill would make a world of difference for stroke survivors facing barriers to telestroke services,” added AHA President Steven Houser, PhD, in the release. “Evidence indicates that telestroke improves patient outcomes and reduces disability. However, nearly 94 percent of the strokes that occur in America take place in areas where telestroke is not paid for by Medicare. We urge Congress to give more Medicare patients access to this proven form of treatment and support the FAST Act.”

There’s no shortage of studies and testimony indicating that telemedicine can save the lives of stroke patients by speeding up the time to clinical intervention – most often, the administration of the clot-busting drug Tissue Plasminogen Activator (tPA) within four hours of a stroke.

In late 2015 the Cleveland Clinic published a study reporting a door-to-CT rate of 13 minutes on average and a door-to-intravenous thrombolysis (IV-tPA administration) rate of 32 minutes on average through the use of a mobile stroke treatment unit. Under normal circumstances, where a patient exhibiting signs of a stroke is rushed to the nearest hospital, those rates average 18 minutes and 58 minutes, respectively.

Last August, Kaiser Permanente released a study showing a 75 percent increase in timely use of tPA following a telemedicine consult.

“These findings have important implications for future delivery of stroke care,” Kaiser Permanente researchers, writing in The Permanente Journal, reported. “Particularly in hospitals with limited local resources and/or limited access to neurologic expertise, telestroke is an important tool to aid in the evaluation and treatment of potential stroke. We specifically found that unwarranted hospital variability in stroke care could be eliminated through a standardized telestroke program. Additionally, telestroke may aid in triage and transfer decisions and in identifying patients potentially eligible for endovascular intervention or patients who might otherwise benefit from transfer to a stroke center.”

“Telestroke has evolved over the last decade and is now used quite extensively to take care of acute stroke patients in the U.S. and the rest of the world,” Lawrence R. Wechsler, MD, chairman of the AHA/ASA writing committee, said. “Because of this we felt it was time to bring out this statement, which provides a structure against which hospitals can measure the quality of their telestroke programs so patients can be assured of getting the quality they deserve.”

Griffith and Beatty’s bill follows by days the resubmission of another piece of telemedicine legislation. Earlier this week, Michigan Sens. Debbie Stabenow and Gary Peters resubmitted the Hallways to Health Act, which aims to boost telehealth services in schools by connecting them with community health centers and create a demonstration project to expend access in underserved areas.

In resubmitting the FAST Act, Griffith recalled how fast action saved the life of Virginia Congressman Bob Bloxom when he suffered a stroke in 2001.

tPA and telestroke ought to be readily available to help improve the chances of recovering from a stroke,” Griffith said.

“Telemedicine has the potential to improve the lives of millions of individuals suffering from chronic conditions.,” added American Academy of Neurology President Terrence L. Cascino, MD, FAAN, in this week’s press release. “Stroke is a condition that needs to be treated immediately in order to minimize damage to the brain. This legislation focuses on expanding access to a proven method for treating strokes quickly.”

“Stroke patients with access to a neurologist have significantly better outcomes than those that do not. Reimbursing for telestroke consultations under Medicare will dramatically increase the number of beneficiaries who have timely access to a neurologist, ultimately producing steep reductions in disability that should save the federal government money.”

“It certainly is a way to relieve some of that pressure on doctors offices, urgent care and ER,” said Dr. Robert Bernstein, vice president of clinical affairs for Carena, a Seattle-based virtual urgent care clinic.

“We see all the urgent care issues from rashes to bladder infections,” Bernstein said. “A lot of coughs and colds.”

MultiCare Health System offers Doctor on Demand. That service provides patients immediate access to a board-certified physician for a range of medical issues. The cost of each video doctor visit is $49.

MultiCare also has eCare. That online service provides online diagnosis and treatment service for common health conditions. Patients are connected to clinicians via email or text for a $25 fee.

HOW IT WORKS

At CHI Franciscan, a patient begins the telemedicine process by calling in or registering through the internet.

Emergency departments can also refer patients. There’s even a mobile app.

CHI Franciscan’s website begins with a series of questions to screen anyone who should instead be calling 911.

Once a patient requests a visit, they will get a call back within 20 minutes, Bernstein said. Though times have lagged a bit during the epidemic, callbacks are still averaging 10 minutes.

Many patients contact the system looking for a medicine to treat their flu symptoms, Bernstein said.

First, “We really have to ask the question, ‘Is this flu or is it something else?’ ” he said.

Physicians look for red flags indicating a more serious condition.

If a patient seems dehydrated, has respiratory involvement, has a complication such as pneumonia or is in a high-risk category, then they will be referred to an in-person visit.

If it turns out the patient needs in-person care, they are not charged for the virtual visit, said Dr. Jessica Kennedy-Schlicher, CHI’s virtual urgent care director.

“It’s really a win-win for the patient and the physician, who wants to provide that access and that convenience but wants to see that patient in the most appropriate location,” Kennedy-Schlicher said.

When that patient is referred to an in-person visit, CHI Franciscan will alert the clinic or emergency department and provide them with appropriate patient records.

IN PERSON VS. VIRTUAL

Bernstein said conversations between patient and provider can often be more engaged when conducted via telephone or webcam. Patients feel more comfortable at home and less intimidated by the medical surrounding.

“They often feel more connected to the provider than in person,” he said.

But, the physicians acknowledged, there are disadvantages.

Physicians can’t use stethoscopes, thermometers and other diagnostic equipment on a virtual patient.

A webcam might show skin color, but not as accurately as an in-person visit would.

Kennedy-Schlicher said doctors can work around those issues.

“Your intuition as a physician gets pretty good over the years,” she said. “If you feel like there’s a piece of information you need, you bring them in. You would err on the side of having more information.”

Telemedicine promises to get more efficient as more tools come online in the coming years.

Patients with chronic diseases, for instance, could have portable diagnostic equipment at home, which could be accessed by physicians.

HEALTH

In an attempt to prevent more doctors from leaving, and perhaps even pull back the hundreds gone over the last couple years, the new governor of Puerto Rico has included in his first package of bills a measure that is basically a lifesaver for the medical profession on the island.

An orthopedic technician attends to a patient at the Medical Center pediatric clinic in San Juan. (AP)

The measure seeks to lower the fixed income tax rate on all practicing physicians, from the current 33 percent to 4 percent. It also proposes a tax exemption for the first $250,000 earned.

Puerto Rico’s governor Ricardo Rosello, a scientist with no political experience, was sworn in last week.

“Puerto Rico’s recovery begins today,” he said in his inauguration speech.

Over the last 12 years, Puerto Rico lost 2,422 doctors – about 347 doctors per year – according to local newspaper El Nuevo Dia, This has led to a dramatic shortage of health services in the island.

“Perhaps without knowing it or having planned it, we are training professionals to go to other places,” said Jaime Plá, executive president of Puerto Rico’s Hospital Association.

“Puerto Rico is becoming the supplier of professionals, not only in the health area but also in engineering,” he said, as quoted by the paper.

Puerto Ricans have been hit with dozens of new taxes in the past four years and increases in utility bills as former Gov. Alejandro Garcia Padilla aimed to generate more revenue for a government he said was running out of money.

Despite those and other measures, the island’s government has defaulted on millions of dollars’ worth of bond payments and declared a state of emergency at several agencies.

Rossello said he also aims to boost public-private partnerships and use that revenue to save a retirement system that faces a $40 billion deficit and is expected to collapse in less than a year.

He pledged to work closely with a federal control board that U.S. Congress created last year to oversee Puerto Rico’s finances, and he has said he supports negotiations with creditors to help restructure a public debt of nearly $70 billion.

The federal control board has requested a revised fiscal plan that has to be approved by end of January, saying that the one Garcia Padilla submitted last year was in part unrealistic and relied too heavily on federal funds — he refused include austerity measures.

Rossello has said he would request an extension of that deadline as well as an extension of a moratorium that expires in February and currently protects Puerto Rico from lawsuits filed by angered creditors.

Many states are experimenting with telemedicine to address health disparities that can depress student achievement.

THE PEW CHARITABLE TRUSTS

Veronica DeSimone, the school nurse at Ducketts Lane Elementary in Elkridge, Maryland, has conducted nearly 25 telemedicine visits with doctors this school year. Telemedicine is becoming more common in schools across the country.

ELKRIDGE, Md. — In late November, on the first cold morning of the season, a second-grader at Ducketts Lane Elementary School had trouble breathing during recess.

When the school nurse, Veronica DeSimone, examined the girl, she heard wheezing in her chest and noted her low oxygen levels. DeSimone determined that the child was having an asthma attack.

The nurse would have administered relieving medication, but the girl’s parents hadn’t yet signed a permission form or delivered their daughter’s medicine to the school. The girl’s father, the only parent available, was at work at least an hour away. There was not time to wait for him to come get his daughter.

Not long ago, DeSimone would have had to call an ambulance to take the child to the emergency room, forcing her to miss the rest of her classes that day.

Instead, DeSimone set up an online video and audio link to an emergency room pediatrician at Howard County General Hospital. With earlier permission from the girl’s parents to participate in the school’s telemedicine program, DeSimone examined her with a digital stethoscope, which allowed the pediatrician to listen to the girl’s lungs remotely.

The doctor quickly confirmed DeSimone’s diagnosis and directed her to administer the necessary medicine. Within 10 minutes, the child was breathing normally and back in class.

Telemedicine, increasingly used in prisons, nursing homes and remote areas, is becoming more common in schools. According to the American Telemedicine Association, at least 18 states authorize Medicaid reimbursement for telemedicine services provided in schools and 28 states plus Washington, D.C., require private insurers to cover telemedicine appointments as they would face-to-face doctor visits.

Telemedicine, increasingly used in prisons, nursing homes and remote areas, is becoming more common in schools.

“The piece for me that is so exciting is how many more kids are able to stay in school,” said Heidi Balter, principal of Ducketts Lane, which was outfitted with telemedicine equipment a year ago.

Lawmakers and educators around the country echo that enthusiasm. “School telehealth will be a game changer in terms of children’s health, keeping them in school and improving educational outcomes,” said Democratic state Rep. Kip Kendrick, who helped pass a new Missouri law that allows Medicaid payments for telemedicine in the schools.

$27,000 in Equipment

Many states still limit Medicaid reimbursement for telemedicine, and, according to the American Telemedicine Association, 24 states specify settings, such as a doctor’s office, where a patient must be in order to participate in a telemedicine appointment.

In Texas, the state Medical Board is involved in a legal dispute over its insistence that “a doctor-patient relationship” be established before telemedicine can be used. The dispute, however, doesn’t apply to school telemedicine as long as a school nurse is present.

But as state policymakers become more accustomed to telemedicine and familiar with its benefits, “we’re seeing many of the restrictions falling to the wayside,” said Latoya Thomas, the director of state policy for the American Telemedicine Association.

The impetus for school telemedicine in Howard County, where Ducketts Lane is located, came from former County Executive Ken Ulman. Ulman believed that health disparities in lower-income areas of the county were depressing student achievement, and that telemedicine might help.

In 2015, the county chose Ducketts Lane and five other elementary schools to be the first to offer telemedicine services. All of the schools drew students from economically disadvantaged areas and all had full-time nurses.

The county found a willing partner in Howard County General, which was looking for ways to expand access to its services. The hospital agreed to pick up the costs of making its emergency room pediatricians available for telemedicine calls from the six schools during school hours.

The county picked up the tab for the $27,000 in telemedicine technology that each school required. The equipment included a video monitor, a camera, and digital stethoscopes and otoscopes, to check ears, noses and throats and transmit the images.

Two local pediatric practices also agreed to make their doctors available. Unlike Howard County General, which is forgoing reimbursement, the practices bill private insurers when the children they treat have that coverage. Maryland Medicaid only covers telemedicine when a doctor or nurse practitioner (not a registered nurse, like most school nurses) is present during the exam.

Quicker Diagnoses

Even when kids must miss school because they have contracted a contagious illness, such as strep throat or conjunctivitis, telemedicine allows remote doctors to make a quick diagnosis and prescribe medicine, hastening the child’s return to school, said Sharon Hobson, the head of telemedicine in Howard County schools.

Often telemedicine doctors are able to rule out a contagious condition, recognizing, for example, that reddened eyes are the result of allergy rather than conjunctivitis. “We used to have to send them home in the chance that it was pink eye,” said DeSimone. “Now we can keep them.”

Last year, the six Howard County schools conducted 150 telemedicine exams. Midway through this year, the total is 87.

Ninety-eight percent of the kids who are treated through telemedicine (not including those who are contagious or have conditions that can’t be treated through telemedicine) immediately return to their classes.

“Not having to pull my child out of school & take him to the pediatrician is a huge benefit,” one parent wrote in a Howard County schools survey. “Saves time & money.”

Managing Chronic Illnesses

In the future, Hobson hopes that telemedicine in Howard County will be able to not only address acute health conditions — the sudden onset of symptoms — but also help students manage chronic conditions, such as asthma, attention deficit hyperactivity disorder and obesity. She also hopes to use telemedicine to provide mental health counseling.

Schools in the Bronx and in South Carolina already are using school telemedicine for mental health. It is being used for speech pathology in Michigan, and in New Mexico, an effort is underway to use school telemedicine in oral health.

The Medical University of South Carolina, in Charleston, provides telemedicine services to 47 schools. James McElligott, the medical director for telehealth at the hospital, said he is most gratified by the work the hospital does with Pace Academy, a school for children with multiple disabilities.

In the past, many of those children simply had to endure minor ailments, such as rashes and earaches, because it was just too difficult to transport them to a doctor or hospital. Now, using telemedicine, the Medical University can provide almost immediate relief.

Some doctors say they actually prefer telemedicine encounters to face-to-face exams with children. David Monroe, medical director of the Children’s Center at Howard County General, said the images provided by the telemedicine instruments are often better than what he can see using conventional equipment on a squirming child. “It’s easier because you get this high-definition picture, which I never get otherwise,” Monroe said.

As more hospitals move from fee-for-service to value-based payment models that reward providers for keeping costs low, telemedicine offers a valuable tool for achieving that goal. Smartphones are everywhere, internet connections are faster and consumers are eager to engage with doctors on their own time from the convenience of their home or office. According to the American Telemedicine Association, more than 15 million Americans receive some kind of remote medical care, and that number was expected to grow by 30% in 2016.

AUTHOR: Meg Bryant

PUBLISHED: Jan. 5, 2017

Reposted by Physician Licensing Service

Health systems are also primed to offer telemedicine services. Expanded access to primary and specialty providers, reduced emergency room visits and inpatient hospitalizations, and improved care coordination among a patient’s providers are some of the benefits telemedicine can provide.

Telehealth technology company American Well already has more than 50 health system partnerships. Among those that sealed the deal last year were New York Presbyterian, Bon Secours, and Baptist Health South Florida.

However, setting up a successful telemedicine practice requires serious planning and fitting a lot of disparate pieces into the healthcare puzzle. The SAMHSA-HRSA Center for Integrated Health Solutions developed a resource guide on starting and sustaining a telemedicine practice. Topics covered include what services to provide, billing and reimbursement, and policy guidelines and considerations.

Sarah Sossong, director of the Center for Telehealth at Massachusetts General Hospital offers seven useful steps in planning and setting up a telemedicine practice.

Identify the site of care (outpatient, inpatient, ER, etc.), pain points and goals for the telemedicine practice.

Establish a structure to support the practice.

Take time to ramp up each specialty regarding operations, legal and regulatory issues and the technological aspects of the practice — software and hardware, training and systems integration.

Determine how telehealth practitioners will get paid. Will it be through some sort of grant funding? Institutional reimbursement? Patient self-pay? Contract? Or public and private payers?

Align to the regulatory and reimbursement environment (licensure, credentialing, practice standards, etc.) in the state or states the organization serves.

Another thing organizations need to consider is whether they should go it alone or partner with an established telemedicine company. Hospitals with limited resources to commit to telehealth and a short timeline to get the practice up and running may see a partnership as a way to address those issues. Vendor demonstrations and partnerships can also help an organization better refine what they are interested in achieving through a telehealth practice, Sossong says.

If a hospital does decide to partner, they should consider the capabilities of the different vendors carefully, she adds. “Partnerships don’t minimize the need for an internal dedicated lead, or team, but they can definitely help you achieve your goal more quickly, though at a cost. The cost of building internal infrastructure can also be significant depending upon your goal,” she says.

Despite enthusiasm for telemedicine, there are some concerns. Telehealth is governed by a patchwork of state regulations, which can be hard to sort out. Interoperability of electronic health records and questions about privacy and security are other potential concerns.

Some physicians may not be comfortable conducting a virtual patient exam, making a diagnosis or presenting a treatment plan without a face-to-face visit. The Texas Medical Board recently began requiring that physicians meet with patients in person prior to providing telemedicine services, which prompted telemedicine company Teladoc to file a lawsuit challenging the rule. This could limit when and how the services are used.

There are also technological costs and challenges. Telehealth services require special software, which in turn require training and support. If either the software or hardware fails during a doctor-patient encounter, the session ends without resolving the health issue that prompted it.

“While there are pros and cons to providing a telemedicine service, I don’t think it’s something that healthcare providers will long have a choice about,” Sossong tells Healthcare Dive. “Telemedicine services are becoming an expectation of consumers. In the same way that I expect that my bank will allow me to deposit checks via a mobile app without going into a brink and mortar facility, consumers will expect that appropriate telemedicine services will be provided by their healthcare provider, and paid for via insurance in the same way that appropriate face-to-face services are paid for.”

What kind of return on investment can organizations expect from a telehealth practice? “The ROI to be achieved depends upon your strategy, you solution and your goals,” Sossong says. Aligned with a population health management strategy, ROI could be improved patient engagement, patient outcomes and/or access to care. It could also be reduced costs via fewer readmissions or emergency room visits.

The global telemedicine market is expected to reach USD 113.1 billion by 2025, according to a new report by Grand View Research, Inc. Key drivers of the market include increasing incidences of chronic conditions and rising demand for self-care. Furthermore, enhancing application of internet and rising demand for centralization of healthcare are expected to save on cost incurred, which is one of the critical success factors attributing for the growth of telemedicine market.

Telemedicine also helps in reducing emergency room visit and hospitalization rate, there by augmenting the market growth. The telemedicine industry is segmented on the basis of products, and region. The service offers prime channel for various providers to communicate on the same platform and thus, centralize all the available data.

Telemedicine products are distributed by direct supply contract amongst the manufacturers and end users or maybe concluded via a third party supplier. Government initiated healthcare programs across the nation are anticipated to propel the direct agreement method by conducting private bidding and voluntarily sponsorship by market players.

Connectivity & network is anticipated to be the fastest growing product segment of this market over the forecast period.

Increasing demand of automation and synchronization across the system is anticipated to be the vital drive for the market growth.

North America, being a pioneer in IT technologies, dominated the global telemedicine market. Available advanced organization with plenty funds contributed to its domination.

Asia Pacific is predicted to witness lucrative growth over the forecast period. Economic reforms, boosting IT industry, and low functioning costs are the key factors attracting market players to participate in this region.

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Researchers compared home-delivered prolonged exposure therapy – which helps patients confront memories and situations that trigger their symptoms – to the same treatment given in U.S. Veterans Affairs clinics, and found no difference in effectiveness.

“The best treatment for PTSD, with the most empirical support, can be delivered at no loss of effectiveness, directly into a veteran’s home, rather than having the veteran come into clinic,” lead study author Ron Acierno told Reuters Health by email.

“We can now save the travel time and bring the treatment right to them” if a veteran lives too far away to attend 12 to 15 weekly sessions, can’t take off work or feels stigmatized coming into the clinic, said Acierno, a psychologist and researcher with the Ralph H. Johnson VA Medical Center in Charleston, South Carolina.

For the study, published in Behaviour Research and Therapy, Acierno and colleagues recruited 132 veterans who had been diagnosed with PTSD, 127 of them men.

All the participants were assessed with standard PTSD scales designed to measure symptom severity and depression. They were then randomly assigned to two groups – each would receive 10 to 12 prolonged exposure therapy sessions, but one group would attend sessions at a VA medical center while the other would have sessions at home by video conference.

The participants who got treatment at home were provided with videoconferencing software to use on their own computers, tablets or smartphones. Videophones or tablets were provided to participants who didn’t own the proper equipment.

The researchers repeated the PTSD scales after three months of treatment and again three months later. They found that at both time points, the vets who were treated at home showed similar improvements in PTSD symptom severity as those treated in the clinic.

The at-home treatment scores for depression were not as good at three months, but by six months they were similar to the scores of the group treated in the clinic.

“Our effects with PTSD were just as good in person vs. home based telehealth,” Acierno said, “however, people doing the treatment via home-based telehealth did report more difficulty.”

About 33 percent of the at-home group did not complete the program compared to 19 percent of the clinic group.

Acierno said participants who dropped out reported difficulties such as feeling worried about losing control during exposures, the feeling they couldn’t tolerate assignments to go out in public and that imagined exposures made them feel bad.

Acierno said he and his collaborator Dr. Melba Hernandez-Tejada are exploring the idea of pairing peers who have been through prolonged exposure therapy and no longer meet criteria for PTSD with veterans currently receiving the treatment via telehealth to help them through the difficult parts of the therapy.

Acierno said the Charleston VA currently offers the home-based therapy to patients.

“We have had tremendous response combining home telehealth with peer support during exposure, which is new,” Acierno said, adding that in the past peers were involved only to encourage people to get into treatment, not actually helping to perform the treatment.

Peter Kane, a psychologist at the University of Wisconsin in Madison said the study was able to show that, at least in the VA health system, effective PTSD treatments can be successfully delivered in multiple ways.

“Patients with PTSD could be treated effectively in the clinic or by using home based telehealth,” Kane said. The findings are especially important given the common barriers that make it harder for those who need these services to access them, he noted.

“Studies such as this one may change how mental health services are delivered in general, not just for PTSD or within the VA system,” Kane said. “It may be the case at some point in the future that mental health clinics may offer home based telehealth as an alternative to traditionally clinic-based care.”

SOURCE: bit.ly/2h6TQfs Behaviour Research and Therapy, online November 22, 2016.